Charles A. Moss, M.D.


Patients seen in a medical acupuncture practice often present complex and multifactorial problems. Many times the basis of these problems is deeply rooted in the body, mind and spirit of the person. Five Element acupuncture offers a systematic approach to identify and treat the underlying root of the energetic disturbance including the spirit level.

The number of patients identified with spirit level disease is estimated at 60% of a typical acupuncture practice. This number has increased dramatically over the past decade. If the level of illness can be recognized, then treatment results will improve. The spirit level patient does necessarily present serious medical problems. Often the main complaints can be a functional disorder or an underlying sense of incompleteness, inertia, dissatisfaction, unhappiness and emptiness. It is this lack of wholeness that drives the patient to seek help and can be addressed through the Five Element acupuncture system.

The challenge of treating these patients has led me to develop a comprehensive approach based on the Five Elements. In addition to the acupuncture diagnosis and treatment, it is possible to identify the attitudes, beliefs and negative emotional states that are related to each of the Five Elements. Through specific suggestions regarding these mind-body connections we can support the effects of treating spirit and mental level acupuncture points. With this comprehensive approach we can help people move towards wholeness and the ideal discussed in the Nei Ching " the first method of acupuncture cures the spirit; the second gives knowledge of how to nourish the body... in order to make all acupuncture thorough and effective one must first cure the spirit."

Wholeness can be described as being conscious of ourselves, being compassionate and loving, and being integrated in body, mind and spirit. Wholeness is following our own path as part of a greater whole and manifesting the positive qualities of the aspects of Spirit of the Five Elements: Shen (consciousness and love), Yi (memories and caring), P'o (truth and the quest for knowledge), Tche (will and actualization), and Hun (emotional expression and manifesting one's destiny). When we are able to assist our patients and ourselves to become whole in relation to these states, we are practicing at the highest level.
The psychoneuroimmunology literature supports the idea that having healthy attitudes, beliefs and emotional states can improve physical health. This information is similar to the ideas connecting body, mind and spirit in traditional acupuncture. Below are a few examples of the mind/body psychoneuroimmunology literature identifying factors which influence the outcome of disease. This is the type of information that can be utilized to support the patient undergoing acupuncture treatment.

in AIDS survivors and healthy elderly people, Solomon found that a positive sense of control, hope and the ability to express anger were correlated with healthier function of the immune system AIDS patients had better survival if they were in charge of their own care, had a determination to live and did things their own way, showed assertiveness, and did not feel overburdened.

AIDS patients had worse outcomes if they had a sense of helplessness, passivity, compliance, suppression of anger or self blame interviews with healthy centenarians showed the following characteristics: sense of optimism, ability to adjust to loss, commitment to something larger than themselves, engagement with other people. Medical students shown a movie of Mother Teresa ministering to the poor in India had increased levels of secretory IgA immediately after watching the movie. In a study of 2700 men, those who did no volunteer work were 3 times more likely to die than those who did regular volunteer work. In lung cancer patients that had the lowest ability to express emotions, there was a 4.5 increase in mortality compared to those who expressed their emotions the most. Women with breast cancer who had a fighting spirit, an optimistic attitude and a belief in their ability to survive had much greater survival rate than those who were stoic or felt helpless. In 430 men, those who had stress in the workplace and at home and suppressed feelings of anger, had the highest incidence of hypertension compared to those who were able to express emotions normally.

Williams measured the level of hostility in medical students and followed them over twenty five years and found a 6 fold increase in cancer and heart disease in those with the highest levels of hostility.
This is just a brief sampling of a huge body of knowledge which now exists. The challenge which faces the clinician is how to utilize this information with your patients. Evaluating which aspects need to be emphasized and how to get people to make the required changes is a difficult and time consuming task. In my practice, I have used much of this information clinically and have been able to individualize specific recommendations for changes in attitude, beliefs and behavioral traits through the model of the Five Elements which is the basis of traditional Chinese medical theory. Additionally, a consistently effective intervention irregardless of the specific problems presented is Mindfulness Meditation.


The Five Element concepts originated several thousand years ago and reflected the Chinese philosophy of observing and living according to the Laws of Nature. Understanding the aspects of the Five Elements in nature was critical to survival and prosperity in an ancient society. The astute observation of the cycles and interactions in nature led to a parallel understanding of how the human organism functioned and how intervention to reestablish a sense of balance and harmony with the cycles of nature could lead to improvement in the disease state.

The Five Element model is based on a system of correspondences. There are macrocosmic correspondences such as the seasons and climactic conditions and correspondences within the person. Each person has a root or causative factor which is the Element which under internal or external stress will become imbalanced and initiate a state of disease. Each Element has correspondences including organ systems, emotional state, attitudes, physical and emotional symptoms, emotional strengths and weaknesses, tendencies towards developing physical and emotional illness and a general orientation toward life. The goal of Five Element diagnosis and treatment is to identify the person's constitution and approach therapy from this perspective and not solely rely on symptoms and complaints as the means of diagnosis.

The goal of the physician is to identify the Element which is the key for the patient. Each Element corresponds to several key areas in the psychoneuroimmunolgy literature. The correlations are striking between the descriptions of the psychoemotional issues for each Element and the modern body-mind literature. The traditional concepts of Five Element acupuncture are as applicable to the life stresses of our society as they were to the Taoists in ancient China.
A specific example of this approach is the following. The Wood Element is related to the function of the gall bladder and the liver, the ocular system and the musculoskeletal system. The key emotional and behavioral correspondences include a need to be highly organized and efficient, tendencies towards frustration and hostility, a need to feel in control much of the time, difficulty in planning and making future oriented decisions. The emotional aspects of Wood include a sense of frustration, inappropriate anger and anxiety.

When a person is identified with the Wood as the key Element in addition to acupuncture treatment, there is a series of recommendations made to help with these tendencies. For example, there is an emphasis to learn to express anger and deal with hostility in an appropriate fashion. The recommendations are based on the psychoneuroimmunology literature and include specific suggestions on dealing with stress, visualization and relaxation techniques, and focusing on the key beliefs and attitudes which impact the particular Element involved. With the Wood element, the acupuncture points that might be chosen that can effect the mind and spirit level include Liv3 (Supreme Rushing), Liv13 (Chapter Gate), Liv14 (Gate of Hope), GB 24 (Sun and Moon), GB 37 (Bright and Clear).


To understand what these Elements represent in man it is helpful to see each Element in relation to its seasonal correspondence. The Wood Element corresponds to the spring, a time of new growth, renewal, expansion, breaking through, rebirth, increasing activity and longer days. In the person the Wood corresponds to having a vision of the future, to organizing and planning one's life, to having the ability to follow ones's destiny, and to express emotions including anger in a healthy way. The Wood Element includes the function of the biliary tract, the liver, the ocular system, and the musculoskeletal system. When not in balance, the Wood person would have findings such as difficulty in making decisions, high level of frustration, inappropriate anger, a need to be overly organized, chronic muscular problems such as fibromyalgia, PMS, headaches including migraine, feeling the need for a high level of control of all situations, anxiety and visual problems.

The Fire Element seasonal correspondence is the Summer. This is a time of greatest warmth and light, the longest days of the year, the greatest activity and growth, a time of expansiveness and interaction. In the person, the Fire Element represents relationships, expression of love and sexuality, connection with other
people, expansiveness, playfulness, joyfulness, being warm and relaxed. The organ systems of the Fire Element are the heart, the small intestine, the pericardium, and the sympathetic and parasympathetic nervous systems. When the Fire Element is not in balance we see a lack of joy and warmth, difficulty in intimate relationships, confusion and doubt in life, hesitation in changing relationships, low energy, digestive problems such as irritable bowel syndrome, insomnia, cardiac disease, tinnitus.

The Earth is correlated with Late Summer. The change from the peak of warmth in Summer to the slightly cooler and more serene time of Late Summer can be subtle, but is recognizable. This is the time of harvesting the bounties of the Earth, where food is plentiful and the warmth and golden light of Late Summer days creates a feeling of relaxation and satiety. The organ systems of the Earth are the stomach, the spleen/pancreas and all digestive processes. In the person, Earth represents nourishment, contentment, harvesting what is needed for self and others, stability and groundedness, orientation and caring for others. The Earth Element is related to one's mother, both biological and Mother Earth. When Earth is not in balance we see a person who can be obsessive, self centered, opinionated, and uncaring. Physical symptoms include eating disorders, upper and lower gastrointestinal disease including peptic ulcer disease and inflammatory bowel disease, sinusitis, frontal headaches and all gynecological disorders.

The season for Metal is Fall or Autumn. This is a time of decreasing light, increasing cold, shorter days, In Autumn trees lose their leaves as they withdraw their energy internally, signaling significant change as the colder (yin) time of the year becomes dominant. In the person, the Metal represents our internal resolve and strength, a sense of value and richness, self worth, self-esteem, vitality, endurance, as well as the ability to eliminate and let go of emotional upsets and grudges. The organ systems of Metal are the lung, the skin and the colon. The Metal is the biological and spiritual Father. When the Metal is out of balance there is depression and sadness, inability to get over loss, lack of inspiration, poor self-esteem, materialism and emotional withdrawal. The physical symptoms associated with Metal are asthma and rhinitis, eczema and other skin disorders, constipation and lower bowel disorders.

The Water Element is correlated with the season of Winter. This is the darkest and coldest time of the year, when the world has slowed down on the outside, yet the seed of new growth lies deep in the ground. In the person, Water represents our deepest reserves, the will to survive, courage, our ability to procreate, movement and flow, backbone and resources, our foundation of energy, self actualization and willpower, trust and faith. The organ systems associated with Water are the bladder, the kidney, the bones and the endocrine system. When out of balance, the Water patient presents fear and a struggle for survival, a lack of reserves and deep fatigue, reduced sexuality, timidity, and a great lack of trust in life and others. Physical symptoms include fatigue and exhaustion, all disorders of the urinary tract, infertility, hypertension, all endocrine disorders, ankylosing spondylitis, and dental pathology.

The diagnosis of which Element is the key factor is not always a simple task. In clinical practice there often are two or three Elements presenting symptoms and signs to sort out. The utilization of appropriate questions and the organization of the history will often lead to the Element which is the causative factor.

Once the specific element is identified and the body-mind-spirit correlates are elucidated, then specific recommendations can be made. Often simply identifying the area that the person needs to work on and having an objective map to use, is enough for major changes to occur. All patients would benefit from instruction in Mindfulness Meditation which allows for the development of an objective and detached view of the self and one's underlying psychological mechanisms. Each Element has specific visualizations and affirmations which can be utilized. I encourage a review of the day and the identification of the events and experiences which relate to the behaviors requiring modification.

The following is an example of working with a patient whose root factor is in the Wood element. The body-mind-spirit correlates needing attention in this patient were his sense of frustration with his life, and the anger he turned against himself. The technique recommended was to review the experience of the day in regards to these issues. In recalling the events of the day and identifying the issue which is needing to be addressed, it is possible to make changes one small step at a time.

Remember the last time you felt frustrated. Close your eyes and take three relaxing abdominal breaths. Slowly review the details of the situation in which the feelings of frustration occurred. Look at the ways in which the outcome might have changed if you reacted with a different approach or plan. Now put into effect this new plan in your mind and see the outcome from a different perspective. Now let go of the feeling of frustration that you have.

With your eyes closed, review the day and remember any times you were angry with yourself for any reason. Go over the circumstances and step back from yourself and objectively see why you got upset. Realize that you did what you did in that moment to the best of your ability and state of mind and let go of the upset and forgive yourself. Do this for every event of the day which triggered these negative feelings. Continue to say 'I forgive myself' and then let it go and move on.
With the use of these techniques, you can empower the patient to change and be able to see himself in control of choosing how he reacts to the situations life presents. These techniques allows one to move to the state of objective awareness known as the 'observer' state. The movement to the 'observer' state is discussed in all paths to clarifying consciousness and can be tremendously liberating. If the patient chooses to practice this daily review and the other suggestions such as affirmations, meditation, and visualization, then behavior and attitudes can truly change.


When dealing with complex patients or looking at ourselves, there are universal aspects of the human experience which can lead to maintaining health or developing disease. These attitudes, beliefs, thoughts and orientation towards life are well organized in the Five Element model which allows us to have a map to use to maintain our health. The Five Elements are guideposts to living in harmony within ourselves, with other people and with the planet which supports our lives. When we do not live according to the laws of nature as discussed in the Five Elements, we will become ill in body, mind and spirit. It is our opportunity as physicians to provide our patients with a path back to wellness which often must include the knowledge of living mindfully with self awareness and compassion.


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